Primary internal fixation in open fractures of tibia following high-velocity gunshot wounds: a single-centre experience

Khatri, Jai Prakash; Kumar, Manoj; Singh, Chander Mohan

doi:10.1007/s00264-019-04387-x

Cited by 9 publications

(6 citation statements)

References 18 publications

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“…In the literature, slow healing of fractures due to firearm injuries is seen at rates between 5% and 8%. [15] Non-union developed at a similar rate in our cases. Successful results were obtained after the second surgical intervention was performed in our patients who developed non-union.…”

Section: Discussionsupporting

confidence: 84%

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Ateşli Silah Yaralanmalarında İlk Müdahale ve Komplikasyonların Yönetimi

Tokyay

Güven

Özkan

et al. 2021

Journal of Contemporary Medicine

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Amaç: Ateşli silah yaralanmaları sonucu ekstremitede yumuşak doku, nörovasküler yaralanmalar ve kemik kırıkları görülmektedir. Bu yaralanmaların şiddete yönelik olması ve adli olayların gençlerde daha sık görülmesi tedaviyi daha da zorlaştırmaktadır. Bu çalışmadaki amacımız, ateşli silahlarla ilişkili ekstremite yaralanmalarında nörovasküler, yumuşak doku yaralanmaları ve kemik kırıklarına aşamalı bir yaklaşımın nihai tedavi sonuçlarına etkisini değerlendirmektir. Gereç ve Yöntem: Bu çalışmada 2015-2020 yılları arasında ateşli silahla ilişkili ekstremite yaralanması olan ve cerrahi tedavi uygulanan 18 yaş üstü hastalar retrospektif olarak değerlendirildi. Hastaların demografik özellikleri, yaralanma bölgeleri, eşlik eden nörovasküler yaralanmalar, ilk müdalede yapılanlar, son tedavi sonuçları, gelişen komplikasyonlar ve komplikasyonların yönetimi değerlendirildi. Bulgular: Çalışmaya katılan 54 hastanın (52 erkek, 2 kadın) yaş ortalaması 28.3 (yaş aralığı 19-61) idi. Otuz iki (%59.2)’si alt ekstremite, 22 (%40.7)’si üst ekstremite ve 5 (%9.2)’i hem alt hem üst ekstremite yaralanması tespit edildi. Üç (%5.5) hastada damar yaralanması, 3 (%5.5) hastada amputasyon ve 6 (%11.1) hastada sinir yaralanması tespit edildi. Altı hastanın beşine (%9,2) fasyotomi uygulandı. En sık karşılaşılan komplikasyon olarak 7 (%12,9) hastada eklem hareket açıklığı kaybıydı. Sonuç: Ateşli silah yaralanmalarında multidisipliner ve hasar kontrollü bir yaklaşımla erken dönemde antibiyoterapi, kemik tespiti ve seri debridmanlar sonrası nihai tedaviye geçilmesi tedavi başarısını olumlu yönde etkilemektedir. Anahtar Kelimeler: Ateşli silah yaralanmaları, Nörovasküler yaralanma, Fasiatomi, Komplikasyonlar.

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Section: Discussionsupporting

confidence: 84%

“…Debridement and temporary external fixation or permanent internal fixation are recommended for these injuries. [3,4,8,14,15] However, discussions on fixation type continue in the literature. In some studies, external fixation has been recommended in high-energy traumas and internal fixation in low-energy traumas.…”

Section: Discussionmentioning

confidence: 99%

Ateşli Silah Yaralanmalarında İlk Müdahale ve Komplikasyonların Yönetimi

Tokyay

Güven

Özkan

et al. 2021

Journal of Contemporary Medicine

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“…In war-related gunshot injuries, flap options cannot be preferred unless the patient is obliged due to the difficulties in the reduction and healing of hand and wrist fractures, due to multiple traumas in the patient. [ 4 , 15 ] As the posterior interosseous flap allows splint applications in postoperative fracture reduction, it is considered to be a better and useful flap method. [ 16 , 17 ] As a result of the present study, it strongly supports the thesis that PIF is the best option in these injured cases.…”

Section: Discussionmentioning

confidence: 99%

A strong reconstruction option for tissue loss on hand and wrist due to firearm injury in the Syrian war

Uçak¹

2021

Medicine

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All of the injuries were the open injuries with bone or tendon structures in the hand and wrist region as a result of the firearm injury (FI) in the Syria. In the study, we assessed the outcomes of the posterior interosseous flap (PIF) on hand and wrist that we used for the Syrian injured people including civilians and soldiers in this War. PIF was applied to 77 patients who composed of 43 female and 34 male that all patients were evaluated for tissue loss resulting from gunshot wounds and injured in the War between 2014 and 2020 years with tissue loss in hand and wrist as a result of FI. The flap survival rate was 100% for all the patients. The dimensions of flaps ranged from 4.1 cm × 2.2 cm to 9cm × 5.4 cm with 0.51 ± 0.12 cm thickness. The mean pedicle length was 6.33 ± 1.08 cm. The surgery for PIF took 68.8 ± 22.1 minutes, while blood loss was 60 ± 24 mL. We observed no palsy conditions including the posterior interosseous nerve. The donor sites were treated by primary intention in the patients. We found the superiority of PIF with the postoperative follow-up comfort, ease of fracture healing, easy and fast, easy-to-apply method and no second additional session requirement in FI patients. We did not detect flap necrosis in any patient or observe a flap-related complication. As a result of the present study, it strongly supports the thesis that PIF is the best option in these cases.

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“…Gunshot injuries should be treated as a separate clinical entity from open humerus fractures caused by other mechanisms [4]. The treatment options for various gunshot fractures range from non-operative to primary internal fixation [5]. Various studies [6] [9].…”

Section: Discussionmentioning

confidence: 99%

High Velocity Gunshot Fractures of Humerus: Results of Primary Plate Osteosynthesis

Kumar¹,

Khatri²,

Singh

2020

IJOO

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Background High velocity gunshot fractures usually seen in conflict zones, often mandate external fixation due to delayed presentation and associated contamination. In the presented observational study, we managed high velocity gunshot fractures of humerus with adequate debridement and primary plate osteosynthesis under controlled conditions with gratifying results. Material and Methods Eighteen consecutive cases of fracture of the humerus secondary to high velocity gunshot wounds with ages ranging from 28 to 45 years reporting within 6 h of the initial injury formed our study group. Immediate debridement, lavage and primary plate osteosynthesis was carried out following hemodynamic stabilisation and intravenous antibiotics. All the cases were followed up at 2, 4, 6 months, 1 year and then annual follow-up including telephonic follow-up for six patients. Results Fifteen cases of Gustillo Anderson type III A, two of type III B and one of type III C were managed with primary plate osteosynthesis. Brachial artery injury was addressed immediately, however injured radial nerve ends were tagged. Five cases showed delayed/non-union and were managed with decortication and autologous bone grafting. Two cases of deep infection could be managed with implant retention till union. The implants were removed following fracture consolidation. All the fractures united and no patient was left with sequelae of chronic infection. Conclusion Timely presentation of high velocity gunshot fractures of humerus teamed up with adequate debridement, soft tissue management and primary plate osteosynthesis can offer satisfactory outcomes. Associated vascular injury needs immediate attention. Nerve injuries can be addressed in a staged procedure. Our results have been satisfactory and add to the scant literature available on the subject, however further studies are warranted.

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Primary internal fixation in open fractures of tibia following high-velocity gunshot wounds: a single-centre experience

Cited by 9 publications

References 18 publications

Ateşli Silah Yaralanmalarında İlk Müdahale ve Komplikasyonların Yönetimi

Ateşli Silah Yaralanmalarında İlk Müdahale ve Komplikasyonların Yönetimi

A strong reconstruction option for tissue loss on hand and wrist due to firearm injury in the Syrian war

High Velocity Gunshot Fractures of Humerus: Results of Primary Plate Osteosynthesis

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